The exclusive private healthcare institution has undergone not only quantitative but also qualitative growth as patients can choose from an increasing number of services. Thus, for example, oncoplasty is available for cancer patients at Dr. Rose Private Hospital. We talked to the reconstructive plastic surgeon, Dr. Béla Ákos Molnár, one of the private hospital’s permanent doctors and a well-known expert.
Plastic surgery is one of the most important fields in the institution. The services offered include everything from breast augmentation and facelifts to intimate surgery. Which are the most popular services these days?
In aesthetic plastic surgery, the most popular services have long been broadly the same: breast augmentation and addressing changes due to pregnancy. Minor facial corrections are still popular, but besides this there is also a lot of interest in procedures such as ear, nose, neck and tummy-tuck interventions. Reconstructive surgery is another area associated with a disease such as breast developmental disorders or breast lump surgery.
Among private health clinics, Dr. Rose may be the only one dealing with oncoplasty. If I am correct, this means that with breast cancer patients, the cancerous area is removed and their condition is restored at the same time…
Yes, our patients wake up after surgery, during which we have performed the oncological procedure and breast reconstruction. This way, their self-confidence is not damaged for a minute. But the primary rule is definitely the oncological norm: complete removal of the tumor with a safety zone, lymph node biopsy, and other procedures based on the protocol.
Prior to this approach, in the case of malignant breast tumors, the removal of the tumor was followed by chemotherapy and radiotherapy, and only much later, years later, breast reconstruction.
Today, we have the opportunity for immediate recovery and in all cases, we strive for this simultaneous surgery. Eighty percent of breast cancer surgeries are already done this way. Of course, this requires a precise treatment plan defined by a diagnostic oncology team of oncologists, surgeons, plastic surgeons, radiologists, and other medical specialists prior to surgery. This is how we decide if breast retention or breast removal surgery is required. With the former, we only remove a portion of the breast, but reconstruction is of course necessary here as well, most of the time using the techniques used in aesthetic surgery to restore the original shape, sometimes with correction of the other breast. The procedure is a bit more complicated when removing the whole breast. In this case, as a replacement for the missing tissues, it is necessary to have some kind of pedicled flap, or we can combine this with implant placement as well.
From where do you most often source the patient’s own replacement tissue for breast reconstruction?
Mostly, from a portion of tissue from the back - if the right breast is affected, tissue is recovered from skin obtained from the back’s right-hand side, and vice versa. By placing the implant under the patient’s own tissue, we can create beautiful breasts. If a larger volume needs to be replaced, abdominal wall tissues are used in a procedure similar to the surgical intervention for tummy tuck surgery. Also included are free flaps prepared by vascular anastomoses under a microscope, the application of which is the next step in our practice.
Is the surgery’s technical composition suitable for all these interventions?
Yes, all the tools are available, all the pre-operative tests can be completed here, plus there are good radiologists and contacts with oncologists, in fact the whole team needed for such a big surgery.
Surgical oncology is quite rare in private hospitals. Is it typical to visit Dr. Rose Private Hospital for oncoplastic surgery?
Increasingly so. Even though oncoplasty was only recently added to our palette, we perform more and more of these surgeries, and this number is expected to grow rapidly. This may be due to the pandemic or to overloaded public health institutions. If the patient has their surgical plan prepared by an oncology team, we can arrange their surgery with us almost immediately.
In terms of equipment, is the private hospital adequately equipped for such complex surgeries?
Yes, for example we too have devices such as the harmonic scalpel, but we apply so-called titanium mesh, not only in tumor surgery but also in aesthetic surgeries, which is extremely tissue-friendly and very stable. With its fine mesh structure of thin titanium fibers, the implants can be well stabilized, for example after complete breast removal.
The term oncoplasty is currently used in connection with breast tumors, although several parts of the body may be affected. Are there examples of other cancerous areas of the body being restored concurrently with oncology treatment?
Oncoplasty can only be used for breast cancer surgery, as the combined knowledge of oncological surgery and aesthetic-reconstructive surgery allows its use. In addition to this, other surgical areas are restored, for example, in head and neck surgeries complete jaw reconstructions can now be performed from lower leg flaps, or facial reconstructions with microvascular anastomoses, but abdominal surgery can also reconstruct the esophagus, which can be recovered from the small intestine, for example.
Is there a chance that more and more breast cancer patients will find a solution at Dr. Rose Private Hospital in the future?
I’m certain that will be the case.